oUijj-ilViul 

A  taSSEKTATlUN   JJN   THE   fc>GLKKUUiil,i! 
OF  THE  FKUtJTKATE  JiLAJNiJ 


V/\-\\cft^ 


^5 


Columbia  Qnteettftp 
itttljeCttpofJtogork 

College  of  ipfjj>£trian£  anb  JSmrgeontf 
Hiorarp 


Digitized  by  the  Internet  Archive 

in  2011  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/dissertationonscOOsull 


%  <Ot$#ertatt0n 


ON 

THE   SCLEROCELE 

OF    THE 

PROSTATE  GLAND, 

WITH 
AN  INQUIRY  INTO  THE  CAUSE  OF  THIS  DISEASE, 

AND   ALSO, 

WHY  THIS  AFFECTION  OCCURS  MORE  PARTICULARLY  IN  OLD 
AND  SEDENTARY  MEN. 

SUBMITTED    TO    THE    PUBLIC    EXAMINATION  OF  THE  PROFESSORS 

OF    THE    COLLEGE    OF    EHYSICIANS   AND    SURGEONS    IN    THE 

UNIVERSITY  OF  THE  STATE  OF  NEW-YORK. 

SAMUEL    BARD,    M.  D.    President. 

FOR   THE    DEGREE   OF 

DOCTOR  OF  PHYSIC, 

ON  THE    7th    DAY   OF   MAY,    1816. 

BY  ROBERT  M.  SULLIVAN,  TYRO. 


"  In  all  the  extent  of  Anatomy,  there  is  not  a  more  important  subject  for 
the  attention  of  the  Surgeon  than  this  of  the  size,  relation  and  connection,  and 
.    with  their  effects)  of  the  prostate  gland."    C.Bell. 


NEW -YORK : 

Printed  by  John  Forbes  <.V  Co. 
73  Wall-strejd 


IHK>. 


/m 


TO 


WRIGHT  PuST,  M.  D. 
PBOFES8°"  op  «»»«  aND  SURGERY 

IH    THE    COLLEGE    OF    Pflv^rr,, 

PHYSICIANS  AND  SURGEONS 

°S    THE    UNIVERSITY 
OF    THE    STAT^    OF    NEW-YORK, 

THIS  DISSERTATION 

IS  RESPECTFULLY  DEDICATED, 

AS  A  TESTIMONY  OF  ESTEEM 
FROM  HIS  PUPIL, 

ROBERT  M.  SULLIVAN. 


TO 

JOHN  K.  RODGERS, 

THIS  DISSERTATION  IS  ALSO  ADDRESSED, 

FOR  THE  MANY  FAVOURS  RECEIVED ; 
AND  AS  A 
TRIBUTE  OF  GRATITUDE 
FOR  PRIVATE  FRIENDSHIP, 

BY  ROBERT  M.  SULLIVAN. 


INTRODUCTION. 


ACCIDENT  determined  my  choice  of  the 
subject  of  the  Prostate  Gland  for  an  inaugural 
dissertation.  The  idea  of  a  cause  for  the  enlarge- 
ment of  the  prostate,  and  of  a  plausible  treatment, 
advanced  before  the  American  iEsculapian  society, 
rereivingthe  sanction  of  an  enlightened  President, 
urged  me  to  attempt  the  execution  of  what  I  had  then 
merely  thought  of:  and  influenced  by  this  consider- 
ation, I  found  myself  engaged  in  a  task,  the  difficul- 
ty of  which,  and  the  want  of  materials  to  perform  it, 
I  was  not  then  aware  of.  I  examined  all  that  was  to 
be  found  in  periodical  works  and  others,  and  find- 
ing the  diseases  of  the  Prostate  Gland  had  had  but 
little  attention  paid  them,  and  that  the  terms  made 
use  of  to  designate  them,  tended  only  to  confuse, 
and  to  cause  practitioners  to  neglect  them  from 
their  formidableness,  I  concluded  I  could  not  do 
belter  than  to  continue  in  my  first  resolution,  and 
if  I  could  not  succeed,  that  I  might  be  profitably 
employed  in  collecting  into  one  view,  what  had 
been  scattered  through  so  many  publications,  and 
endeavour  to  cast  a  little  more  light  upon  a  sub- 
ject apparently  so  intricatn. 


Till 

I  have  also  endeavoured  to  point  out  why,  and 
in  what  manner  this  disease  does  occur  in  old  and 
sedentary  men.  I  have  done  this  the  more  readily, 
because  many  circumstances  of  their  lives  have  an 
agenGy  in  producing  that  condition,  which  I  have 
ventured  to  assign  as  the  cause  of  the  enlargement 
of  the  Prostate  Gland  in  advanced  age,  and  more 
particularly  in  literary  persons  who  lead  a  life  of 
seclusion.  This  disease  occurring  oftener  in  such 
persons  than  in  others,  should  of  itself  be  an  incen- 
tive to  exertion  on  our  part  to  find  out  some 
alleviation  for  those,  who  have  toiled  and  earned 
their  complaint,  as  we  might  say,  in  our  service. 

M.  Tissot  observes,  "  II  y'a  long-temps  qu'on  a 
remarque  que  l'etude  des  sciences  etoit  peu 
favourable  a  la  sante  du  corps."  Why  such  a 
life  affects  the  general  health  of  the  body  to  which 
the  author  here  alludes,  is  evident  enough :  but 
how  the  Prostate  should  become  affected  by  it, 
may  perhaps,  at  first  view,  not  be  altogether  so 
clear.  Yet  I  trust  we  shall  see,  that  the  Prostate 
Gland  may  be  affected  by  "  Fetude  des  sciences" 
as  well  as  the  body  in  general. 

It  is  much  to  be  regretted  that  these  men,  with 
their  great  strength  of  mind,  are  so  very  blind  to 
the  welfare  of  their  body,  for  "  On  est  trop  savant 
quand  on  Test  au  depens  de  sa  sante ;"  unless  they 
are  closeted  they  are  unhappy,  they  become 
misanthropes,  avoid  that  society  in  which  were 
they  to  indulge,  they  would  be  the  fitter  afterwards 


IX 

for  greater  mental  exertion,  and  they  might  be 
enabled  to  continue  their  labours  longer,  for  the 
benefit  of  those  around  them,  and  to  their  own 
greater  comfort.  For  to  adopt  the  language  of  M. 
Tissnt,  a  quoi  sert  la  science  sans  le  bonheur  ? 

On  the  subject  of  the  enlargement  to  which  the 
Prostate  Gland  is  liable,  there  never  was  any 
separate  treatise  written  before  that  of  Mr.  Home, 
which  has  not  yet  general  circulation  in  this 
country.  Whatever  else  is  written  concerning  it,  is 
scattered  through  the  various  periodical  publica- 
tions, in  the  form  of  cases,  from  which  we  learn 
nothing  but  the  symptoms  of  a  retention  of  urine, 
and  the  dreadful  certainty,  that  nothing  had  been 
done  for  the  patient.  To  some  of  these  cases  the 
detail  of  a  dissection  is  given,  the  parts  cut  through 
enumerated  ;  and  as  to  the  state,  appearance, 
texture,  size,  and  condition  of  the  gland,  and  the 
state  of  that  part  of  the  urethra  connected  with 
it,  not  one  word  is  said.  We  are  told  what  we  knew, 
hy  the  examination  per  anum,  before  the  body  was 
opened,  that  the  Prostate  Gland  was  enlarged. 
It  is  to  such  vague  methods  of  procedure,  that  we 
are  to  attribute  the  little  knowledge  we  possess  of 
the  precise  state  of  the  parts  affected. 

The  general  appellation  of  these  cases  is,  en- 
largement  of  the  Prostate  Gland.  Some,  however, 
by  way  of  diagnostic,  called  it  a  Schirrus ;  and 
with  tbifl  attempt  they  also  have  remained  satisfied, 

B 


which  has  become  the  cause  of  others  neglecting 
them  in  the  same  shameful  manner:  for,  if  it  beschir* 
rus,  say  they,  there  is  nothing  to  be  done,  it  is 
incurable,  the  patient  must  die.  "Perhaps  our 
curiosity  has  been  checked  by  a  recollection  of 
the  ability  already  displayed,  and  the  acknow- 
ledged superiority  of  investigation,  already  de- 
voted to  the  morbid  history  of  this  gland."  Such 
is  the  language  of  Mr.  Ramsden,  in  speaking 
of  several  morbid  enlargements,  to  which  the 
testicles  are  subjected.  Of  the  morbid  state  to 
which  the  Prostate  Gland  is  subject,  we  have 
not  so  much  to  say.  Perhaps,  then,  it  is  from 
the  testicles  being  considered  a  more  import- 
ant organ,  that  they  have  received  so  much 
more  investigation  than  the  Prostate  Gland:  but 
to  consider  a  disease,  merely  because  it  is  situated 
in  a  part  important  in  itself,  without  having  refer- 
ence to  its  effects  upon  the  constitution  or  life  of 
a  being,  is  certainly  an  incorrect  method  of  pro- 
ceeding. Hence,  although  the  Prostate  Gland 
does  not  stand  so  high  in  the  estimation  of  the  in- 
dividual, as  his  testicles,  the  consequences  resulting 
from  the  disease  of  the  former,  are  by  far  more 
troublesome  and  dangerous  than  those  which  can,  in 
any  way  arise  from  the  most  inveterate  disease  to 
which  the  latter  are  subject.  Nay,  the  consequences 
of  an  enlarged  Prostate  Gland,  are  even  such  as  to 
hurry  the  patient  into  an  untimely  grave,  with 


XI 

the  most  exquisite  anguish  attending  it.  Besides, 
the  patient  in  the  case  of  an  enlarged  Prostate, 
is  denied  from  its  situation  the  advantages  known 
to  result  from  local  applications,  which  are  easily 
made  to  the  testicles,  and  if  these  fail  of  success, 
and  if  the  disease  assumes  a  character  which  nei- 
ther local  nor  general  means  can  subdue,  the  pa- 
tient has  always  left  the  resource  of  extirpation. 
Not  so  of  the  Prostate  Gland,  situated  internally, 
and  surrounded  by  parts  of  high  consequence  to 
the  animal  economy,  which,  as  it  enlarges,  it  excites 
to  such  a  degree,  that  sooner  or  later,  an  excruciat- 
ing death  must  ensue  from  the  secondary  affections 
of  these  organs. 

What  the  causes  of  the  enlargement  of  the 
Prostate  Gland  are,  and  with  what  species  of  disease 
it  is  affected,  little  has  been  said  more  than  mere 
conjecture,  and  that  not  very  plausible. 

Among  the  causes  have  been  enumerated  psora, 
tetters,  venereal  virus,  &c.  But  the  grand  one 
of  all  is  scrofula,  which  has  been  assigned, 
forsooth,  because  the  diseased  part  is  a  gland, 
and  this  as  a  cause,  has  been  set  down  by 
those,  who  do  not  believe  that  that  disease  ever 
affects  the  body  after  the  twenty-fifth  year  :  with 
such  causes,  and  the  incurable  nature  of  scrofula, 
they  have  been  pleased  to  rank  an  enlarged  state 
of  the  Prostate  Gland,  with  the  opprobria  medico- 
rum  :  all  that  has  been  done  in  the  way  of  treat- 


•    • 


Xll 


inent,  has  been  performed  without  any  reference 
to  causes,  for  the  palliation  of  symptoms  present, 
and  the  prevention  of  more  serious  ones. 

"  Causes  are,"  it  is  true,  "  for  the  moist  part 
obscure  :"  but  surely  when  so  important  a  part  is 
concerned  as  the  Prostate  Gland,  we  ought  to  make 
some  endeavours  towards  their  discovery.  Let  us 
work  from  supposition,  from  hypothesis,  from 
analogy,  or  from  theory :  where  we  cannot  succeed 
from  the  two  soundest,  viz.  analogy  and  theory, 
let  us  have  recourse  to  the  others  :  open  the  pjxth, 
and  perhaps  it  will  be  followed  more  assiduously, 
and  may  lead  to  some  important  facts  which  will 
tend  to  the  alleviation,  if  not  to  the  cure,  of  a 
hitherto  fatal  affection. 

It  is  believed  we  have  attempted  this  work  from 
theory,  and  from  analogy,  but  one  less  iaterested, 
and  considering  every  thing  impartially,  might  say, 
it  is  mere  Hypothesis  :  for  says  Tristram  Shandy, 
"It  is  the  nature  of  an  Hypothesis,  when  once  a 
"man  has  conceived  it,  that  it  assimilate  every  thing 
"to  itself  as  proper  nourishment,  and  from  the  first 
"moment  of  your  begetting  it,  it  grows  the  stronger, 
"by  every  thing  you  see,  hear,  read,  and  under- 
"  stand."  This  is  an  observation  which  every  man 
who  pretends  to  write  upon  the  treatment  of  a  dis- 
ease, the  theory  of  which  he  himself  has  formed, 
should  keep  in  mind,  and  be  able  to  see  distinctly 
every  side  of  the  question.  It  does  in  some  degree 


sin 

apply  to  the  present  performance.  I  have  assi- 
milated to  it  not  what  I  have  seen,  for  that  is 
nought;  but  what  I  have  read,  heard  and  under- 
stood; how  far  I  have  done  tiiis  fairly,  I  shall  leave 
for  others  to  determine. 

The  French  journalists  have  certainly  the  credit 
of  having  done  more  in  the  way  of  investiga- 
tion of  this  important  affection  than  their  boast- 
ful neighbours.  To  M.  Dessault,  particularly,  we 
are  indebted,  for  at  all  events,  he  has  found  out 
the  method  of  curing,  although  he  has  apparent- 
ly not  troubled  himself  much  concerning  the  cause, 
of  this  disease. 

But  the  English,  priding  themselves  upon  their 
superior  surgery,  pretend  to  reject  every  thing 
that  is  any  way  of  French  origin,  although  they 
frequently  acknowledge  them  their  masters  in 
medical  surgery,  by  their  numerous  plagiarisms: 
how  M.  Dessault,  has  escaped  them  this  time,  is  a 
little  surprising. 

It  proves,  however,  the  advantages  American  sur- 
geons possess.  For  by  their  impartiality,  they  reap 
the  fruit  of  the  labours  of  both. 

The  opinion  advanced  in  this  thesis,  concerning 
the  cause  of  this  morbid  enlargement,  and  of  its 
occurring,  for  the  most  part,  in  old  and  sedentary 
men,  although  not  altogether  new  in  regard  to 
another  affection,  with  which  analogy  suggested 
the  idea,  is  so,  as  far  as  I  am  aware,  in  its  appii- 


XIV 

cation  to  the  disease,  to  which  at  this  advanced 
time  of  life,  the  prostate  gland  is  more  particularly 
subject. 

It  is  also  advanced,  that  the  diseases  to  which 
the  prostate  gland  has  been  supposed  for  so  long 
a  time  subject,  arise  from  this  sole  cause,  and  that 
it  is,  instead  of  schirrus,  varicose  enlargement, 
scrophula,  &c.  affected  but  with  one  species  of 
enlargement,  and  to  which  disease,  the  term  Scle- 
rocele  of  the  Prostate  Gland  (as  indicating  its  true 
state  of  hardness)  may  be  applied  with  the  same 
correctness,  that  it  has  lately  been  to  a  similar 
affection  (as  will  be  shown)  of  the  testicle,  by  that 
accurate  observer  Mr.  Ramsden. 

Upon  what  data  I  have  been  led  to  found  these 
opinions,  I  shall,  in  the  following  pages  endeavour 
to  show. 


A  DISSERTATION 


SCLEROCELE 


PROSTATE  GLAND,  &c. 


THE  first  effects  of  confinement,  and  want  of  exercise, 
show  themselves  in  a  plethora  of  the  blood-vessels. 
When  this  confinement  is  accompanied  with  hard  study,, 
and  intense  thought,  this  plethora,  or  fulness,  shows  itself 
in  the  brain,  in  consequence  of  the  excitement  this  organ 
undergoes,  thereby  determining  a  greater  flow  of  blood  to 
it,  at  the  expense  of  the  lower  parts  of  the  body :  from 
which  circumstances,  they  being  deprived  of  their  neces- 
sary quantity  of  blood  for  the  due  execution  of  the  natu* 
ml  functions,  these  are  imperfectly  performed ;  the  secre- 
tions are  diminished,  while  the  absorption  is  going  on  as 
usual;  hence  arises  a  languid  state  of  the  bowels — "  Le 
cerveau  qui  est,"  to  use  the  language  of  M.  Tissot,a  "  le 
theatre  de  la  guerre,  les  nerfs  qui  en  tirent  leur  origine, 
■t  I'estomac  qui  a  beaucoup  de  nerfs  tres  sensibles,  sont 
lea  parties  qui  en  souffrent  ordinairement  le  plutot,  et  le 
i,hi   <ii,  travail excemf&e  L'esprit :  mais  il  n'y  en  a  presque. 

J  Trait!  dfla  saute  des  Gens  de  lettres  p.  21 . 


1(3 

aucune  qui  ne  s'en  ressent  si  la  cause  continue  long-temps 
a  agir."  Then,  as  the  author  observes,  the  cause  is  conti- 
nued for  a  longer  time :  a  siccity,  if  I  may  be  allowed  the 
expression,  of  the  bowels  ensues ;  digestion  is  but  partially 
performed,  the  materials  taken  in  become  acrid,  and 
what  passes  oft'  is  of  a  foul  irritating  quality.  For  "  the 
man  who  thinks  the  most  digests  the  worst,  ceteris  pari- 
bus ;  and  he  who  thinks  the  least,  with  him  digestion  is 
more  easily  and  completely  performed." 

The  parts  which  suffer  most,  are  those  in  which  the 
vessels  naturally  weak,  stand  most  in  need  of  help  to 
keep  up  the  activity  of  the  circulation  through  them, 
such  as  the  organs  contained  in  the  abdomen;  the  action 
of  respiration,  when  it  is  strong  presses  during  inspiration, 
all  the  viscera  of  the  abdomen,  and  thus  facilitates  the 
circulation  through  them :  but  this  action  of  respiration 
in  ■sedentary-  men,  being  much  diminished  from  what  it  is 
naturally,  in  consequence  of  want  of  exercise  of  the 
body,  which  excites  this  function  powerfully;  the  intes- 
tines from  the  want  of  this  accustomed  stimulus,  fall 
into  a  state  of  constipation,  collections  are  formed  in  the 
lower  portion  of  the  canal,  which  by  their  long  residence 
become  acrid,  irritating  the  vessels  of  that  part,  and 
those  in  its  vicinity,  and  by  the  pressure  which  they 
make  upon  the  hemorrhoidal  veins,  preventing  the  return 
of  blood  in  them,  occasion  piles,  a  most  troublesome  and 
painful  affection,  to  which,  according  to  common  obser- 
vation, men  of  a  sedentary  and  studious  life  are  more  par- 
ticularly subject 


17 

The  very  attitude  of  these  persons  becomes  a  cause  of 
this  disease.  "  Le  pli  que  les  vaisseauxsouffrent  au  haut 
de  la  cuisse  et  sous  les  genoux  dans  un  liomme  assis  (for 
they  are  few  who  study  otherwise  than  assis,)  "  genent  la 
circulation  dans  les  parties  inferieures,  qui  a  la  longue  en 
souffre  necessairment :  La  courbure  du  corps  gene  les 
visceres  du  bas  ventre,  leur  fonctions  sont  troublees,  les 
digestions  eprouvent  une  nouvelle  cause  de  deratigement'; 
le  sang  qui  a  de  la  peine  a  remonter  dans  les  veines  du 
bas  ventre  s'accumule  dans  celles  du  fondement  ou  il  est 
determine  par  son  propre  poids  et  ou  il  trouve  moins 
de  resistance ;  de  la  vient  que  les  savants  sont  si  souvent 
ourmentes  par  les  hemorrhoides."  &c.b 

From  such  a  disordered  state  of  the  bowels,  which  at 
first  was  caused  by  the  great  exertion  of  the  mind,  and 
which  now  preponderates,  the  mind  and  whole  nervous 
system  become  affected  ;  they  become  hypochondriacs  and 
misanthropes,  avoid  all  company,  and  seclude  themselves 
from  the  world,  thus  aggravating  all  their  complaints  by 
their  still  more  sedentary  life.  As  an  example  of  this  af- 
fection of  the  mind,  we  may  adduce  the  instance  of  Pierre 
Jurieu,  so  celebrated  for  his  theological  discussions,  who 
became  so  much  affected  in  this  way,  that  he  attributed 
his  frequent  and  violent  colicks  to  the  presence  of  seven 
knights,  who  were  imprisoned  in  his  bowels,  and  were 
there  settling  their  disputes  by  the  sword." 

'•  Tiv»ot  »le  la  nattU-  de  g-«-ns  t\e.  Lettr^f 

e 


18 

The  Rectum  lies  in  contact  with  the  prostate  gland, 
and  membranous  portion  of  the  urethra.  When  the  former 
becomes  in  any  way  diseased,  the  latter  most  generally 
becomes  secondarily  affected,  becoming  exceedingly 
irritable ;  so  much  so  as  to  lay  the  foundation  of  a  perma- 
nent stricture0,  and  which  may  be  entirely  removed  by 
the  use  of  the  bougie,  never  more  to  return,  icithout  the  same 
cause  being  previously  established.  A  spasmodic  stricture 
is  sometimes  occasioned  by  a  lesser  degree  of  irritation, 
as  costiveness,  the  removal  of  which  will  allay  the 
spasm.d 

That  piles  and  other  tumours  in  the  rectum,  to  wHch 
V?e  have  shewn  that  old  and  sedentary  men  were  particu- 
larly obnoxious,  will  occasion  irritation  in  the  urethra^ 
may  be  inferred  from  the  fact  mentioned  by  M.  Valentin8 : 
That  those  persons  who  are  affected  by  goitre  are  more 
particularly  subjected  to  attacks  of  the  croup,  the  irrita- 
tion which  this  tumour  occasions  in  the  trachea,  predis- 
posing such  persons  to  the  influence  of  this  disease,  more 
than  others. 

Besides  this  secondary  affection  of  the  urethra  in  old 
and  sedentary  men,  there  are  many  circumstances  exist> 
ing  in  them,  which  go  to  produce  this  irritation  directly. 
To  commence  with  every  day's  observance;  that  these 
men  are  particularly  liable  to  calculous  complaints,  which 
no  doubt  are  occasioned  by  the  causes  already  mentioned, 

.  c  Lux  more  on  the  Urethra. 
d  Weldon,  ohs.  §c. 
e  Recherches  sur  le  croup. 


19 

uamely,  the  great  derivation  of  blood  from  the  lower 
parts  of  the  body,  in  consequence  of  which,  the  urine 
passes  off  loaded  with  a  greater  proportion  of  salts ; 
whereas,  in  those  where  a  regular  circulation  exists,  they 
are  attenuated  by  the  greater  quantity  of  urine  which  is 
secreted.  Not  only  is  the  urine  more  acrid  in  old  people 
than  in  youth,  but  the  secretions  in  general  are  more  or 
less  so.  M.  Tissot  observes,  "  Leur  acrimonie  mine  par 
degre  le  corps,"  and  Dr.  Rush,  in  corroboration  of  this 
says,  that  the  first  sign  of  old  age  is  a  more  frequent  call 
to  evacuate  the  bladder/  From  what  can  this  arise,  un- 
less it  be  from  the  acrid  urine  irritating  that  naturally  (but 
which  at  this  time  of  life  is  rendered  still  more  so)  irritable 
part,the  neck  of  the  bladder,  and  membranous  portionof  the 
urethra  ?  It  may  be  said  to  be  caused  by  the  stimulus  of  the 
urine  upon  the  coats  of  the  bladder.  But  it  is  well  known 
that  the  bladder  itself  in  old  age  loses  much  of  its  natural 
sensibility.  That  those  men  who  have  led  a  temperate  life, 
and  have  always  been  attentive  to  the  exercise  of  the  body, 
ie  whom  we  may  conclude  there  can  exist  but  avery  trifling 
degree  of  irritation,  if  any,  in  the  urinary  organs,  except 
they  be  very  much  advanced  in  age,  will  frequently  re- 
tain their  urine  for  a  great  length  of  time;  and  the  blad- 

L<  i  itself  so  insensible  as  to  become  completely  distend- 
ed in  all  points  ;  and  they  are  admonished  of  the  necessity 
of  evacuation,  only  by  the  urine  dropping  from  the  end  of 
tli  . -nis.  Xot  so  in  him,  who  leading  a  sedentary  life  eon* 
joined  with  <;!<!  age  ;  his  vessels  are  full,  his  excretions  acrid. 

ItnshV   liK|inri''r 


20 

he  is  subject  to  piles  and  other  diseases  of  the  rectum,  to 
which  the  other  has  lived  a  stranger,  has  a  degree  of  irrita- 
tion established  in  that  part  of  the  urethra  adjoining*  the 
seat  of  these  diseases,  which  goes  on  increasing,and  becomes 
so  extremely  irritable  at  last,  that  the  smallest  quantity 
of  urine  stimulates  it  to  such  a  degfee  as  to  give  him  the 
sensation  of  the  necessity  t6  evacuate  it.  To  this  may  be 
added  the  bad  practice,  that  men  deeply  engaged  in  study, 
are  accustomed  to  defer  evacuation  as  long  as  possi- 
ble :  unwilling  to  interrupt  their  train  of  thought ;  an  ac- 
cumulation of  this  acrid  material  takes  place,  and  irritates 
the  neck  of  the  bladder,  which  induces  a  temporary  spasm 
in  the  membranous  portion ;  "  and  the  action  of  the  blad- 
"  der  and  abdominal  muscles,  pressing  the  urine  against 
"  the  diseased  part,  keeps  up  a  constant  irritation,  which 
"  renders  the  disease  more  obstinate." 

This  portion  of  the  urethra  is  the  mOst  debilitated  part 
of  the  canal,  from  the  greater  action  it  has  been  accustomed 
to  perform  ;  for  in  it  terminate  the  ducts  of  the  testicles  and 
those  of  the  Prostate  Gland,  which  are  naturally  excited 
every  time  there  is  an  emission  of  semen.  Again,  it  is  a 
well  known  fact,  that  men  advanced  in  age,and  those  youn- 
ger who  have  led  debauched  lives,  lose  the  power  of  emis- 
sion, and  frequently  that  Of  the  erection  of  the  penis,  from 
the  end  of  which  the  fluid  of  the  prostate  excerns. 

Men  at  this  age,  and  particularly  those  who  lead  se- 
dentary lives,  have  always  great  calculous  deposits(as  before 
observed)  from  their  urine :  frequently  completely  formed 
stones^  as  in  the  disease  termed  the  gravel,  are  passed ;  but 


2i 

■  dthough  they  may  not  be  actually  troubled  with  this  form 
of  disease,  yet  matter  of  a  sabulous  nature  frequently  ex- 
ists, and  it  is  impossible  for  this  to  pass  through  the  ure- 
thra without  irritating  it,  more  particularly  that  most  de- 
licate and  naturally  very  sensible  part,  which  lies  between 
the  bulb  of  the  urethra  and  the  neck  of  the  bladder,  a  par; 
of  which  passes  through  the  Prostate  Gland. 

In  an  old  man,  the  slightest  excess  in  wine,  or  even  ex- 
sure  to  cold  or  wet  feet,  will  sometimes  cause  a  spasm  of 
the  urethra,  followed  by  a  complete  retention  of  urine, 
which  undoubtedly  must  imply  a  state  of  canal,  far  from 
natural  :  should  he  retain  his  urine  much  beyond  the 
time  he  is  admonished  of  the  necessity  of  evacuation, 
he  will,  most  likely,  experience  very  great  difficul- 
ty in  passing  it,  and  frequently  all  his  efforts  of  straining 
are  fruitless,  he  is  unable  to  perform  this  duty,  un- 
til relieved  by  opiates,  the  warm  bath,  and  such  other 
means  as  are  employed  to  allay  spasm,  to  the  presence  of 
which,  at  the  neck  of  the  bladder,  is  to  be  attributed  the 
difficulty  he  experiences,  and  not  to  paralysis  from  over 
distention  :  for,  in  such  cases,  recourse  must  be  had  to  the 
catheter  immediately,  not  once  only,  but  perhaps  for  se- 
veral days,  to  prevent  the  least  accumulation  of  urine,  that 
the  bladder  may  again  retrieve  its  contractile  power;  where- 
as,in  the  former  case,  the  patient  is  no  sooner  released  from 
the  spasm  of  the  urethra,  than  all  obstruction  to  the 
fr.-c  [>>-:rjr  is  rfmoved,  .'nid  the  bladder  is  then  capable 
icuating  its  contents  ;  for  ithas  not  lost  the  power  of 


22 

contraction,  as  it  does  when  affected  by  palsy,  from  the 
overstretching  of  its  coats* 

In  these  cases,  the  retention  comes  on  in  a  less  time  than 
in  those  from  paralysis,  and  before  the  bladder  has  had 
sufficient  time  to  become  much  distended:  it  must  there- 
fore imply  a  previous  morbid  state  of  the  canal,  which 
could  so  predispose  it  to  be  acted  on  by  this  degree  of 
stimulus.  This  morbid  state  consists  in  an  irritability 
of  tii  at  part. 

Gonorrhoea  contracted  in  youth,  very  frequently  leaves 
behind  it  an  irritable  morbid  state  of  the  urethra,  which, 
w  hen  aggravated  by  the  circumstances  already  mentioned, 
as  occurring  particularly  in  old  men,  will  occasion  stric- 
tures to  make  their  appearance,  many  years  after  the  con- 
traction of  the  disease,  as  happened  in  a  case  recorded  in 
the  Parisian  ChirurgicalJournal  of  Dessault,  of  aman  aged 
fifty-two  years,  who  had  had  a  gonorrhoea  twelve  years 
before,  who  was  for  all  that  time  afterwards,  subject  to 
habitual  smartings,  which  were  succeeded  by  real  pain, 
and  at  length  a  disposition  to  contraction  took  place  in  the 
urethra,  §c.  Here  tuen  we  find,  that  even  the  diseases 
of  the  urethra,  contracted  in  youth,  become  a  source  of 
future  disease  in  that  canal,  by  the  irritation  they  leave 
behind  them.  In  the  above  case,  this  "  morbid  principle" 
existed  to  so  great  a  degree,  that  the  man  for  all  that  time 
of  ter wards  ic as  subject  to  habitual  smartings,  and  sensible  of 
its  diseased  state,  until  it  manifested  itself  more  decidedly 
by  a  contraction  of  that  canal.  But  for  the  most  part  it 
leaves  behind  it  a  lesser  degree  of  irritation,  of  which  the 


23 

patient  is  no  wise  conscious.  Fvenstricturemay  exist,  and 
to  a  considerable  degree,  without  tiie  patient  being  aware 
ot  it.s 

"  This  fact  can  only  be  accounted  for,  by  reflecting  on 
the  slow  and  gradual  manner  in  which,  in  cases  of 
strictures  the  canal  sometimes  becomes  lessened,  and  the 
stream  of  urine  diminished,  and  by  considering  that  the 
slight  irritation  which  would  from  time  to  time,  attacn  to 
3ucu  a  state  of  urethra,  as  might  easily  be  disguised 
under  the  excitements,  which  are  daily  experienced  in 
the  urinary  passage,  by  ttiose  who  indulge  in  the  luxuries 
ol  the  table."h. 

Strictures,  mostly  are  found  occurring  in  the  mem- 
branous part  of  the  urethra,  denoting  it  to  be  naturally 
the  most  irritable  portion  of  the  canal ;  but  a  stricture  in 
any  other  part,  even  if  near  the  orifice  of  the  urethra,  or 
an^  other  circumstance,  preventing  the  uninterrupted 
flow  ol  the  urine,  or  emission  of  semen,  will  establish  a 
degree  of  irritation,  or  morbid  sensibility  in  the  lower 
extremity  of  this  canal ;  and  most  old  men  have  some 
impediment  to  the  free  evacuation  of  their  urine. 

To  those  causes  occurring  in  youth,  of  which  we  have 
already  referred  to  one,  ailecting  the  urethra  with  "  a 
latent  irritation,  at  an  advanced  period,  may  be  added  an- 
r,  which,  we  may  say  more  than  any  other  concurs  in 
establishing  this  morbid  state  ot  the  urethra,  w  ich  is 
that  most    horrible  and  unnatural  vice,    onanism;  and 

«  Kamjden  ■'  IHtrf. 


24 

from  the  facility  of  gratifying  their  passions, ■;  they  are 
unfortunately  in  the  habit  of  repeating  this  act  of  self 
pollution  so  frequently,  as  to  reduce  themselves  to  the 
lowest  degree  of  wretchedness. 

If  these  persons  should  become  of  a  studious  disposi- 
tion, and  lead  in  consequence,  a  sedentary  life,  the  evil  is 
increased.  They  then  become  misogynists,  and,  "  Le 
travail  du  cabinet  rend  les  hommes  delicats,  affoiblit  leur 
temperament  et  fame  garde  difficilement  sa  vigueur  quand 
le  corps  a  perdu  la  sienne.  L'etude  use  la  machine, 
epuise  les  esprits,  detruit  les  forces,  enerve  le  courage, 
rend  pusillanime,  incapable  de  resister  egalement  a  la  peine 
et  aux  passions?"  They  give  way  to  them,  and  in  conse- 
quence of  the  mechanical  violence  done  the  part,  from 
severe  manipulation,  irritation  is  the  more  readily  esta- 
blished in  the  urethra ;  and  ■*  when  it  is  the  result  of  pre- 
ternatural muscular  action,  or  of  excitement,  it  is  not  confi- 
ned to  so  distinct  a  point,  neither  is  it  so  acutely  sensible, 
but  consists  rather  of  a  tenderness  of  the  membrane,  and 
particularly  of  that  part  of  the  canal  which  is  within  the 
Prostate  Gland."k 

The  facility^  with  which  these  persons  gratify  their  pas- 
sions, causes  them  to  repeat  it  the  more  frequently,  thus 
debilitating  the  canal,  and  more  certainly  establishing  an 
irritable  state  of  the  urethra.  Nay,  the  frequent  repetition 
of  this  act,  from  the  great  violence  offered  those  delicate 
parts,  has  been  known  to  cause  stricture. 

1  J.  J.  Rousseau  pref.  dc  Narcisse,  osuvres  divers  Tom.  I.  p.  172, 
j°  Ramtden  on  Scleroeele3  p.  41, 


25 

"  The  causes  tending  to  produce  a  derangement  of  the 
membrane  of  the  urethra,  are  too  numerous  to  admit  of 
being  distinctly  specified  ;  many  of  them  are  very  remote, 
and  others  probably  too  minute  or  latent,  to  be  discovered 
by  surgical  investigation.  In  general,  it  may  be  said  that 
whatever  occasions  a  frequency  of  muscular  action  upon 
the  urethra,  {as  onanism)  or  a  frequency  of  excitement 
within  it,  or  whatever  induces  a  temporary  inflammation3 
{as  gonorrhcea)  may  establish  a  state  of  irritation  in  its 
membrane1.  Thus  constitutional  irritability,  {which  is 
present  in  advanced  life,)  high  living,  excess  in  venery,  in- 
dulgence in  onanism,  gonorrhceal  inflammation,  irritating 
injections  {particularly  in  the  constitutional  irritability  al~ 
ready  referred  to,)  calculi  in  the  bladder  or  kidneys,  piles 
ami  other  affections  of  the  rectum,"  &c.  {which  occur  for 
the  most  part  in  advanced  life  only,)  may,  and  does  actually 
lay  the  foundation  of  an  irritation,  which  will  remain  ia* 
tent  in  the  urethra,  until,  to  it  be  added  the  general  cir~ 
cu instances  occurring  in  old  age,  such  as  piles,  calculi,  and 
those  already  pointed  out  as  more  particularly  affecting 
Qm  urinary  organs  in  advanced  life  ;  it  will  then  demon* 
atrate  itself  by  the  affection  of  some  remote  part. 

We  have  now  endeavoured  to  show,  by  a  chain  of 
circumstances  connected  with  a  studious  and  sedentary- 
lite,  how  these  tend  to  affect  the  urinary  passage  par- 
ticularly |  some  of  which  we  have  shown  to  ariect  the 
■m-thra    in  a  secondary    and   remote   manner;  bui   tne 

Ramid«n,  on  Sclerocelc,  p.  35 — et  sequent 


26 

greater  number  of  which  have  a  direct  operation  in 
producing  irritation  in  the  membranous  portion  of  the 
urethra;  which  irritation  remains  "  latent"  during  the 
greater  part  of  the  life  of  the  persons-only  becoming- 
sensible,  when,  to  it  have  been  added  the  various  circum- 
stances connected  with  old  age,  and  then  manifesting  itself 
by  the  disease  it  causes  in  some  remote  part. 

It  is  to  the  presence  of  this  "  latent  principle"  in  the 
urethra  of  most  old  and  sedentary  men,  that  we  have 
ventured  to  ascribe  the  enlargement  of  the  Prostate  Gland, 
which  occurs  more  particularly  at  this  time,  in  those  who 
have  led  that  kind  of  life. 

Except  we  admit  this  cause  as  existing  in  the  urethra, 
or  some  other,  which  obtains  in  all  old  men,  how  will  the 
fact  that "  it  is  a  rare  occurrence  for  a  man  to  arrive  at 
eighty  years  of  age,  without  suffering  more  or  less  under 
disease  of  this  part  ;"m  that  is,  of  the  Prostate  gland,  be 
accounted  for  ? 

Various  causes  have  been  assigned  for  the  nature  and 
production  of  this  disease ;  but  none  I  believe  for  its  oc- 
currence  in  old  men  particularly  ;  but  the  same  cause 
which  occasions  it  in  old  men,  may  exist  in  those  who 
are  younger:  it  being  prematurely  produced  in  these  last 
by  some  violence  done  to  the  parts. 

It  has  been  supposed  subject  to  several  morbid  de- 
rangements ;  all  of  which  have  received  different  appella- 
tions :  such  are  schirrus,  scrofula,  enlargement  of  its  ducts, 

™  HomePract.  Ops.  on  the  treatment  of  the  diseases  of  the  Prostate  Gland,  p.  18. 


27 

through  which  the  urine  insinuates  itself,  enlarging  and 
irritating  the  Gland,  and  frequently  causing  serious  mis-, 
chief:  calculi  in  the  ducts,  "which  are  for  the  most  part  of 
a  brown  colour,  differing  in  their  composition  from  com- 
mon urinary  calculi." 

These  distinctions  are  well  enough,  serving  as  materials 
for  the  lengthening  of  a  book ;  for  most  assuredly,  the  per* 
son  who  made  them,  could  never  have  been  able  to  dis- 
tinguish them  in  practice,  allowing  them  for  a  moment  to 
be  correct,  that  he  might  vary  his  Modus  Medendi,  either 
to  give  tone  to  the  mouths  of  the  ducts,  to  prevent  their  im- 
bibing the  urine,  or  after  they  had  done  so,  to  counteract 
the  acrimony  of  this  fluid,  that  it  should  not  irritate  the 
body  of  the  gland ;  nor  did  he  I  suspect  ever  find  out  any- 
solvent  for  these  wonderful  calculi,  which  differ  so  en- 
tirely from  the  urinary,  and  which  although  so  very  small 
as  to  be  scarcely  perceptible,  he  was  enabled  to  analyze  so 
minutely. 

The  term  scrofulous  enlargement,  it  is  probable,  has 
been  assigned  because  the  diseased  part  happens  to  be  a 
gland,  and  is  continued  in  consequence  of  no  persons  trou- 
bling themselves  to  search  for  a  better.  This  source  of  it 
has  been  mentioned  by  authors,  in  other  parts  of  whose 
writings  we  are  told  that  Scrofula  does  not  affect  the  body, 
after  the  age  of  twenty-five  or  thirty  years  :  yet  they  have 
prescribed  recipe  after  recipe  of  calomel,  and  cicuta  for 
the  promotion  of  absorption  in  it.  It  is  surprising  that  be- 
* ui_*  the  king's  evil  they  had  not  employed  the  royal  touch 


28 

t&  t^e  part,  or  rubbed  it  with  a  dead  man's  band,  the  older 
panacea  far  t  at  complaint. 

The  term  schirru&has  been  applied  for  the  same  reason ; 
the  disease  being  an  indurated  gland.  One  author  des- 
cribes a  Schirrus  of  the  prostate  in  the  following  words : 
"  it  is  often  found  of  a  cartilaginous  texture ;  but  more 
frequently  of  the  appearance  of  hog's  skin,  and  appears 
filled  with  a  kind  of  inspissated  lymph. 

"  Sometimes  it  is  increased  to  double,  sometimes  triple 
its  natural  size.  Sometimes  we  find  the  whole  gland  affected 
with  schirrus,  and  at  others  we  find  it  only  partially  affec- 
ted with  this  kind  of  induration. 

**  The  hardness  of  the  gland  can  sometimes  be  discover- 
ed by  the  introduction  of  the  finger  into  the  rectum* 
which  is  attended  with  little  pain."(m) 

The  definition  given  by  writers  of  schirrus,  is  nearly  as 
follows :  a  hard  tumour,  with  craggedness  of  surface* 
with  a  red  or  livid  appearance,  attended  with  Severe  Ian* 
cinating  pain,  and  derangement  of  general  health. 

M.  Dessault's  comparison  of  the  hog's  skin,  does  not 
much  correspond  with  cragginess  of  surface;  and  how 
he  could  so  misname  it,  to  call  it  schirrus,  we  confess  our* 
selves  a  little  surprised,  when  we  read  the  last  paragraph, 
of  his  description,  that "  the  hardness  of  the  gland  can  be 
discovered  by  the  introduction  of  the  finger  into  the 
Tectum,  which  is  attended  with  tittle  pain." 

The  enlargement  of  the  ducts  of  the  Prostate  Cland* 

(™    Dessau  If  s  Chirur.  Journal  *  p.  186. 

*  Mr  Weldon  describing-  the  method  of  introducing  the  Catheter  in  cases  of 
enlarged  Prostate,  observes,  that  the  end  of  it  may  be  entangled  in  some  of  the  en- 


29 

is  occasioned  by  debility,  which  cannot  exist  without  a 
concomitant   irritability  of  that  part  of  the  urethra    in 
which   they  terminate.     The  calculi  which  are  found  in 
the   Prostate  Gland,  or   rather  in   the  extremities   of  its 
ducts,  are  not  created  from  any  disposition  this   part  has 
to  form  stones,  but  they  are  produced  similarly  to  those 
mentioned  by  Morgagni.    Speaking  of  calculi  formed  be- 
hind the  prepuce,  he  quotes  the  observation  of  Littre,  on 
a  boy,  "  who  having  a  phymosisthat  prevented  his  urine 
"  being  properly  discharged,  this  fluid  for  that  reason 
u  stagnated  betwixt  the  Glans  and  the  prepuce,  none  of 
"  which  were  any  more  produced  after  the  phymosis  was 
"  removed11 :"  in  like  manner,  the  Prostate  Gland  being 
at  first  a  little  indurated  and  altered  in  size,  forms  an  im- 
pediment, like  the  Phymosis  in  the  case  referred  to,  to  the 
free  passage  of  the  urine,  allows  time  for  the  deposit  of  cal- 
culous matter,  which  becomes  an  additional  source  of  irrita- 
tion to  that,  which  had  already  caused  the  Gland  to  en- 
large, and  which  now  goes  on  increasing  until  a  total  ob- 
struction is  offered  to  the  free  passage  of  the  urine.  Again, 
"  in  some  instances  the  affection  of  the  Prostate  Gland  be- 
"  comes  the  actual  cause  of  the  formation  of  calculus,' 
(in  the  bladder.) 

"  The  bladder  never  being  completely  emptied,  the 
dregs  of  the  urine,  if  I  may  be  allowed  the  expression, 
bring  nevei  evacuated,  a  calculus  formed  on  a  nucleus  of 

lar^H  lacuna',  or  in  the  excretory  ducts  of  the  Ve.siciilie,  which  are  generally  en- 
larged.    Olis  on  I'unct.  the  bladder,     p.  108. 

(n)  Alexander'!  Morgajrni  Let.  XL.  art.  8, 


3D 

the  ammoniaco-magnesian  phosphate  and  mucus  is  pro- 
duced, when  it  would  not  have  been  produced  under 
other  circumstances.0 

As  to  the  "  dregs"  never  being  evacuated,  we  can  con- 
ceive, on  the  authority  of  Mr.  Weldon,  that  some  does 
pass  off,  and  make  its  deposit  upon  the  ducts  of  the  pros- 
tate, who  says?  "  there  is  no  disease  singly,  except  spasm, 
can  produce  a  retention  of  urine  so  permanent  &c."  as 
totally  to  obstruct  the  passage  of  it. 

It  thus  happens  that  stones  are  found  in  the  Prostate 
Gland.  Instead  of  being  formed  by  it,  they  are  there 
deposited,  and  by  the  irritation  they  occasion,  are  the  cause 
of  the  prostate  enlarging. 

There  is  another  species  of  enlargement  of  this  Gland, 
which  has  been  noticed  by  M.  Dessault,  and  which  he  has 
called  Varicose  Enlargement  of  its  Vessels,  and  of  those 
which  ramify  in  the  cellular  substance  which  connects 
the  neck  of  the  bladder  to  the  beginning  of  the  urethra." 

"  From  anatomy  we  learn,  that  these  vessels  form  a 
plexus  obvious  to  the  eye.  This  vascular  plexus  is  sus- 
ceptible of  considerable  dilatation,  and -we  may  often  re- 
mark a  species  of  "  knobby  projection  about  the  neck  of 
the  bladder,  similar  to  varices  situated  in  other  different 
parts  of  the  body." 

These  varicose  vessels  of  the  cellular  substance  of  the 
prostate,  he  compares  to  haemorrhoids,  with  which  he 
says  they  are  often  complicated. 

0  Home,  Obs,  treat,  of  Prost.  Gland,  p.  40. 
p  P.  98. 


31 

He  accounts  for  this  varicose  state,  somewhat  in  the  fol- 
io wing  manner ;  "violent  contractions  of  the  abdominal 
muscles,  by  strongly  compressing  the  viscera  contained  in 
the  abdominal  cavity,  will  occasion  a  difficulty  in  the  re- 
turn of  the  blood  by  the  iliac  and  mesenteric  vessels, 
which  will  produce  a  distention  of  the  veins  in  perineo, 
and  necessarily  occasion  a  swelling  of  the  connecting 
parts."* 

This  it  may  be  said,  at  first  view,  accounts  for  the  cir- 
cumstance of  an  enlarged  prostate  being  met  with  in  old 
and  sedentary  men,  who  from  the  costive  and  debilitated 
state  of  their  bowels,  are  obliged  to  make  greater  efforts 
with  the"  abdominal  muscles,"  to  evacuate  their  feces  ; 
and  that  it  may  arise  independently  of  any  irritation  in 
the  urethra.  But,  that  it  does  not  so,  we  will  shew  by 
M.  Dessault's  words  in  the  same  paragraph :  "  In  this 
"  case,  the  varicose  swelling  of  the  prostate  is  consecutive 
"  to  the  retention  of  urine :"  in  which  case  we  have  al- 
ready shewn  irritation  to  be  present. 

All  these  various  distinctions  of  the  affection,  to  which 
it  has  been  supposed  the  prostate  gland  is  subject,  we 
conceive  to  be  no  way  different,  neither  as  relates  to  tic 
causes  which  were  conceived  to  give  rise  to  them,  nor  in 
the  effects,  as  they  shew  themselves  in  the  alteration  of 
structure  which  the  gland  undergoes;  and  none  of  them 
partaking  in  any  degree  of  the  form  of  disease  which  has 
beeflSSOribed  to  each.     They  are  better  classed  under  the 

t  Chirurj,'.  Journal,  [).  1«2. 


32 

one  general  denomination  of  Sclerocele,  or  hard  tumour  of 
the  prostate  gland,  in  conformity  to  Mr.  Ramsden,  who 
has  applied  it  with  so  much  perspicuity  to  the  affection  of 
the  testicle,  arising  from  the  same  cause :  the  difference  of 
structure  in  the  two  parts  occasioning  the  variety  of  ap- 
pearance, which  may  be  observed,  when  altered  in  their 
constitution  by  disease. 

That  the  affection  of  the  prostate  resembles  that  of  the 
testicles,  is  proved  by  the  similarity  of  the  descriptions 
given  of  the  two  diseases.  Mr.  Ramsden  says,  "  in  illus- 
"  trating  this  opinion,  it  is  to  be  remarked  that  when  a 
11  testicle  is  affected  by  true  schirrus,  as  it  is  termed,  its 
"  morbid  alteration  will  be  found  within  its  organic 
"  structure  ;  but  when  the  Gland  becomes  indurated  and 
"  enlarged,  in  consequence  of  exterior  causes  of  excite- 
(t  ments,  the  morbid  symptoms  are,  in  the  first  instance, 
"  entirely  confined  to  the  surrounding  or  intervening  cellular 
"  substance"* 

M.  Dessault,  describing  the  induration  to  which  the 
prostate  is  subjected,  has  the  following  :  i(  In  this  disease, 
the  body  of  the  prostate  is  less  enlarged  than  the  cellular 
substance  ishich  invests  it,  the  texture  of  which  is  some- 
times soft  and  spongy,  sometimes  dense  and  hard,  in  pro* 
portion  to  the  length  of  time  the  complaint  has  exist- 
ed."9 

In  addition,  we  may  add,  the  characteristic  marks  of  the 
tumor.  First,  of  the  testicle ;  "  as  the  induration  advances, 

*  Pref.  Obs.  on  the  Sclerocele,  p.  13. 
s  Chirnrgical  Journal. 


35 

it  acquires  a  peculiar  callosity  and  cragginess  ike."1  Des- 
sault  speaking  of  the  affection  of  the  prostate,  observes; 
— "we  may  often  remark  a  species  of  Knobby  projection 
about  the  neck  of  the  bladder  &c." 

The  similarity  is  still  more  remarkable  in  relation  to  the 
advance  of  the  disease:  "  the  morbid  derangement  is  so 
subtle  at  its  commencement,  and  its  progress  is  so  extreme- 
ly gradual,  that  the  disease  seldom  becomes  the  object  of 
surgical  investigation,  until  the  patient's  attention,  is  either 
attracted  by  the  inconvenient  bulk  of  the  tumor,  or  some 
accidental  circumstance  occurs,  and  diverts  it  from  its 
usual  course." 

"  There  is  scarcely  an  instance  of  Sclerocele  of  the  tes- 
ticle, which  does  not  corroborate  this  remark,  by  bearing 
incontestible  evidences,  of  its  having  existed  long  before 
the  time,  at  which  the  patient  dates  the  discovery  of  his 
complaint." 

The  same  is  observed  of  the  prostate,  which  may  be  en- 
larged for  many  years,  without  the  patient  being  aware  of 
his  situation,  and  if  he  h;is  led  a  temperate  life,  and  avoids 
all  violent  exercise,  he  may  never  become  conscious  that  he 
ie  any  way  disordered  ;  but,  if  he  has  led  a  contrary  course 
of  life,  even  then  he  is  only  made  sensible  of  the  diseased 
state  of  tins  part,  by  the  effect  it  produces,  in  preventing 
the  free  evacuation  of  the  urine. 

W<-  bave  been  Bhown  most  ably  by  Mr.  Ramsden,  in 
his  valuable  practical  observations,  how  irritation  appli- 
ed to  the  termination  of  the  vasa  defereritia,  will  cause 

'    Kainsden  prac  obf. 

i: 


34 

the  testicles  to  enlarge,  and  to  become  indurated.  From 
analogy  we  may  determine,  a  similar  cause  applied  to  the 
extremities  of  the  ducts  of  the  prostate,  will  cause  an  en- 
largement and  induration  of  this  gland. 

"  It  appears  to  me  more  than  probable,  that  the  indu* 
rated  liver  of  the  spirit  drinker,  which  is  commonly  called 
sc  irrus,  is  an  effect  of  continued  and  habitual  irritation 
in  the  duodenum,  at  the  extremity  of  the  ductus  com- 
munis choledochus,  entering  that  intestine.  There  are 
rio  two  parts  of  the  human  body  which  on  first  mention, 
would  be  supposed  to  bear  less  resemblance  to  each  other, 
than  the  liver  and  the  testicle  ;  yet,  on  investigation,  it  will 
be  discovered,  there  exists  a  particular  analogy  between 
them.  The  liver  has  its  excretory  duct  terminating  in  a 
channel  (the  duodenum)  exposed  to  continual  irritation 
from  free  living.  When  such  irritation  in  the  duodenum 
has  been  kept  up,  or  continued  to  a  great  extent,  this  vis- 
gus  becomes  hardened  and  enlarged  ;  an  effusion  takes 
place  into  the  cavity  of  the  abdomen,  and  constitutes  as* 
eites.  The  testicle  has  its  excretory  duct  also  terminating 
in  a  channel  (the  urethra,)  which  is  exposed  in  a  variety 
ef  ways  to  irritation.  When  this  irritation  is  established, 
or  is  continued,  the  gland  becomes  indurated  and  enlarg- 
ed ;"  &c.  u  But  how  much  greater  is  the  analogy  between 
the  prostate  gland  and  the  testicles,  than  between  these 
last  and  the  liver :  it  has  its  ducts  terminating  in  the  same 
channel,  (the  urethra)  where  they  are  exposed  to  I  e 
same  causes  which  establish  irritation  at  the  extremities 

J  Ramsden  note,  p.  11. 


35 

of  the  ducts  of  the  testicles,  and  it,  in  like  manner,  be=> 
comes  Sclerocele  or  hard  tumor,  progresses  in  t  ie  sane 
way,  and  puts  on  the  same  appearance  as  the  testicles 
When  they  are  affected  from  this  cause. 

That  irritation  once  established  in  the  urethra,  can 
affect  the  prostate,  we  infer  from  the  analogy  existing 
between  it  and  the  testicle,  which  we  know  to  be  frequent- 
ly so  affected,  the  induration  of  which  cannot  be  resolved, 
unless  this  channel  be  restored  to  its  natural  state,  by  the 
continued  use,  for  a  certain  time,  of  the  bougie.  We 
know  that  from  the  long  retention  of  urine  in  the  blad- 
der, the  kidnies  will  be  affected  by  inflammation  and 
induration.  "  Independent  of  general  causes,  the  kidnies 
are  subject  to  be  affected,  by  a  particular  species  of  in- 
flammation, from  diuretics,  the  internal  exhibition  pi* 
external  application  of  cantharides,  stones  in  the  kid- 
nies, long  retention  of  the  urine  in  the  bladder  &c."v 
If  irritation  applied  to  the  termination  of  the  ureters 
in  the  bladder,  can  thus  produce  inflammation  of 
the  kidneys,  I  cannot  conceive  why  we  should  not 
believe,  that  irritation  applied  to  the  extremities  of  the 
ducts  of  the  Prostate  Gland,  should  not  cause  an  enlarge- 
ment of  it ;  for  certainly  in  the  latter  case,  the  part  is 
not  so  remote  from  the  seat  of  the  cause,  as  the  kidnies 
an;  from  the  bladder:  the  apparent  ditference  of  t!.e 
disease  produced,  is  to  be  attributed  to  the  very  different 
Structure  of  the  parts  concerned;  the  kidney  bring 
infinitely  of  more  delicate  organization  than  the  subsume- 

'  lk»3ault  Chirurg.  Journal  p.  ti3. 


36 

of  the  Prostate  Gland,  so  that  irritation  applied  to  the 
extremities  o\  its  ducts  (the  ureters)  causes  an  acute 
inflammation  of  it ;  but,  the  Prostate  Gland  being  a  part 
of  much  less  delicate,  structure,  is  affected,  from  the  same 
cause,  acting,  by  a  chronic  inflammation  of  its  substance, 
the  difference  of  organization  occasioning  the  variety 
which  exists,  in  the  appearance  of  the  disease. 

Again,  calculi  in  the  kidnies,  will  cause  suchrirritation  at 
the  beginning  of  the  urethra,  as  to  induce  a  spasm  and 
complete  retention  of  urine,  as  is  confirmed  by  Morgagni, 
in  whose  works  we  read :  "  in  our  man,  therefore,  to 
whom  I  now  return,  a  calculus  which  was  already  gene- 
rated (in  the  kidnies)  might  bring  on  both  the  pain  of  the 
loins  and  the  suppression  of  urine,  either  by  shutting  up 
the  upper  part  of  the  ureter  or  the  beginning  of  the  lire- 
ijirah:' 

That  Calculi  in  the  ureters,  from  the  irritation  they  oc- 
casion, will  cause  the  kidnies  to  enlarge,  is  proved  by 
another  observation  from  the  same  author.  Speaking  of  an 
apoplexy  he  says;  "  to  omit  many  other  examples  of  an 
apoplexy  itself,  being  brought  on  by  suppression  of  urine, 
and  particularly,  that  of  Koenigius,  in  a  senator,  whose 
ureters  were  obstructed  with  calculi,  and  whose  kidnies 
the  right  in  particular,  were  much  enlarged  beyond  their 
natural  size[*)." 

The  above  examples  of  analogy  might  suffice  to  estab- 
lish the  possibility,  that  irritation  at  the  extremities  of 

(w)  Alexander's  Morgagni,  Let.  XL.  art.  5. 
(x)  Ibid. 


37 

the  ducts  of  the  prostate,  will  cause  it  to  enlarge;  but  I 
cannot  forego  the  mention  of  two  facts,  still  more  in  point. 
A  puncture  in  the  end  of  the  finger,  will  occasion  the 
glands  in  the  axilla  to  inflame,  and  to  become  enlarged ; 
and  a  corn  upon  the  toe,  "  is  capable  of  inducing  a  flinty 
induration  and  enlargement  of  the  inguinal  glands,  with- 
out in  itself  being  sufficiently  painful,  to  awaken  the  at- 
tention of  the  patient  to  the  part,  on  which  it  is  situated. 
In  these  cases,  indeed,  not  only  the  source  of  irritation,  but 
the  affected  Gland  also,  will  be  so  entirely  free  from  un- 
easiness, that  the  induration  will  often  advance  to  a  con- 
siderable size,  before  the  patient  becomes  conscious  of 
it(>)  :"  moreover  the  reality,  that  frequently  only  one  of 
the  lobes  of  the  Prostate  Gland  is  enlarged,  makes  tl  e 
analogy  between  it  and  the  Sclerocele  of  one  testicle  aris- 
ing from  irritation  in  the  urethra,  still  stronger. 

That  the  enlargement  of  the  Prostate  Gland  is  caused  by* 
irritation,  is  corroborated  by  a  review  of  all  the  cases  of 
tin-  disease  upon  record  ;  in  which  we  will  find  that  the 
patients  have  been  universally  affected  by  gonorrhoea,  by 
stricture,  by  calculus  or  some  one  of  those  causes  which 
We  have  shown  to  establish  irritation  in  the  urethra.  In 
those  cases  recorded  by  Mr.  Home,  (than  whom,  perhaps 
no  one  has  met  with  as  many  cases  of  this  disease,)  the  intro- 
duction  of  an  instrument  was  attended  with  difficulty, 
from  the  catheter  reaching  the  diseased  part,  being  grasp- 
ed bj  a  spasm  of  the  urethra;  which  clearly  proves  great 
irritation  to  have  existed  iii  that  part 

1  Kamsdcn  Tract.  Obi.  p  \f>. 


Having  gone  so  far  in  attempting  to  establish  that  the 
same  cause,  (irritation)  which  produces  the  sclerocelc 
of  the  testicle,  is  the  same  which  causes  an  enlarge- 
ment of  the  Prostate  Gland,  it  may  not  be  mal-apro- 
pos  to  take  a  review  of  the  treatment  which  has  been 
employed  by  different  surgeons,  for  the  discussion  of  the 
swelling  of  this  part,  to  see  how  far  it  goes  to  corroborate, 
from  the  similarity  of  it,  to  that  instituted  by  Mr.  Ramsden, 
in  the  treatment  of  the  former,  that  the  same  cause  which 
exists  in  the  enlargement  of  the  testicles,  is  present,  in  the 
induration  of  the  prostate. 

"  When  the  urine  is  completely  retained,  (in  that  form 
of  the  disease  termed  varicose  enlargement)  it  is  necessary 
to  introduce  a  catheter.  After  the  evacuation  of  the 
urine,  by  means  of  the  catheter,  it  should  be  suffered  to 
remain  in  the  bladder.  Its  presence  in  the  urethra  be- 
comes necessary  to  dissipate  the  swelling  of  the  prostate,  as 
well  as  of  that  portion  of  the  urethra  which  passes  through 
it. 

"  A  perfect  cure  cannot  be  expected  in  less  than  site 
weeks  or  two  months  of  this  treatment,  and  even  then,  t!>e 
patient  is  subject  to  a  relapse.  To  prevent  this  from  ta- 
king place,  the  use  of  bougies  should  be  relinquished  by 
degrees,  and  they  should  be  worn  in  the  night  even  after 
the  cure  has  apparently  taken  place."* 

In  reading  the  above  passage  in  M.  Dessault's  Chirurgical 
Journal,  I  thought  the  position  advanced  in  this  dissertation 

?  Dessault's  Chirurg.  Journal  p.  185, 


39 

was  not  novel,  but  had  for  support  the  authority  of  that 
great  surgeon.  I  was  however  disappointed,  by  his  obser- 
vation, that  the  bougies  removed  the  enlargement  of  the 
prostate  gland  by  its  pressure  ;  making  a  comparison  be- 
tween it  and  the  varicose  enlargement  which  takes  place 
in  the  veins  of  the  leg,  in  which  case  we  know  pressure 
to  be  successful.  But  I  ask  for  it  to  be  so,  if  it  is  not  neces- 
sary that  it  should  be  equable,  and  universal  to  produce 
any  good  effect.  Is  not  universal  and  regular  pressure,  as 
necessary  to  cure  varicose  enlargements  in  one  part,  as  in 
another?  And  would  not  the  partial  pressure  of  a  bougie 
in  the  urethra,  acting  on  one  side  only,  have  rather  a  tenden- 
cy to  aggravate,  than  to  resolve  this  morbid  state  of  ves- 
sel ?  Yet  we  cannot  pretend  to  deny  that  M.  Dessault  has 
performed  the  cures  he  relates ;  it  is  more  reasonable, 
however,  to  suppose  that  he  has  only  mistaken  the  cause 
of  the  enlargement ;  and  the  success  which  attended  the 
."  treatment  by  the  urethra,"  is  of  the  most  convincing  kind. 
He  admits,  however,  the  success  from  the  use  of  the 
bougie  in  these  cases,  is  not  to  be  attributed  "  wholly  to 
compression ."  He  says,  "  their  residence  in  the  canal  in- 
duces  a  kind  of  phlogosis  in  this  part  and  in  the  prostate, 
which  assist  the  subsidence  of  this  swelling."f  In  another 
part  of  his  Journal,  he  adds,  (speaking  of  the  affection 
which  he  calla  schirrus)  it  is  a  disease  to  which  old  wen, 
and  those  who  have  had  frequent  "onorrhias,  are  particu- 
larly liable.  Notwithstanding  it  he  schirrus,  he  cures  it 

al'Hi  iherame  method,  as  he  docs  the  former  affectum  ;  bui 
i  r.  Dewanlt 


40 

Bow  it  acts  in  this  case  he  has  not  clearly  told  us.  It  will 
not  do  to  suppose  that  it  acts  by  pressure  in  removing  a 
schirrus !  that  I  think  would  rather  aggravate  it.  He 
seems  however  to  entertain  a  fanciful  idea  of  the  enlarge- 
ment of  the  prostate  being  discussed,  by  virtue  of  the  in- 
creased discharge  which  the  bougie  caused;  for  his  words 
are  "the  use  of  the  bougies  should  not  be  relinquished 
till  the  discharge  occasioned  by  their  presence  is  stopped, 
and  the  prostate  reduced  to  its  natural  size,  Avhich  general- 
ly does  not  take  place  till  the  thirtieth  or  fortieth  day  af- 
ter the  treatment,  and  sometimes  not  till  a  later  period." 
A  most  complacent  schirrus  this,  that  it  should  subside 
with  the  same  treatment  and  in  less  time,  than  common 
varicose  state  of  the  vessels  !  for  in  the  latter  case  he  al- 
lows six  weeks  for  its  discussion. 

How  the  bougie  acts  is  pretty  evident,  and  sufficiently 
evinces  the  disease  to  be  not  a  schirrus  affection  of  the 
part,  for  doubtless,  in  this  case,  it  would  hasten  its  progress 
to  ulceration. 

Mr.  Home  makes  use  of  a  similar  treatment,  but  he 
only  continues  it  until  the  patient  is  enabled  to  evacuate 
his  urine,  and  not  till  the  disease  is  removed.  He  also  in 
some  instances  attempted  to  excite  a  discharge  from  the 
urethra,  but  by  more  violent  means;  as  the  smearing  the 
bougie  with  some  stimulating  ointment,  yet  he  could  not 
succeed,  it  only  caused  a  violent  degree  of  inflammation 
without  any  discharge  following.  In  some  of  his  cases  the 
patient  continued  the  use  of  the  catheter,  and  had  the 


41 

swelling  of  their  prostate  removed,  some  in  two,  others  hi 
four  weeks  after  the  first  introduction. 

But  as  the  patient  is  seldom  or  ever  conscious  of  his 
situation,  until  the  prostate  has  so  enlarged  that  it  com- 
pletely shuts  up  the  orifice  of  the   urethra,  the  use  of  the 
bougie,  or  cathetermay  beobjected  to  from  a  supposition 
of  the  impossibility  to  pass  them. 

Mr.  Weldon,  in  attempting  to  introduce  the  catheter, 
persisted  in  his  endeavours  for  near  one  hour  and  a  half, 
and  ultimately  succeeded  in  getting  it  into  the  bladder: 
which  circumstance  encourages  us  to  continue  our  efforts 
a9  long  as  there  is  no  apparent  danger  of  inflammation  of 
the  bladder  coming  on,  from  its  over  distention :  he  found 
the  same  difficulty  in  passing  it  for  the  five  days  following ; 
but  after  this  time,  the  impediment  gradually  ceasing,  he 
was  enabled  to  introduce  it,  with  comparative  facility. 

From  these  circumstances  I  conclude,  that  the  introduc- 
tion of  the  catheter,  lessening  the  irritability  of  the  ure- 
thra, removed  the  cause  of  the  disease,  and  the  enlarge- 
ment of  the  prostate  gradually  decreased,  for  we  find  that 
he  could  not  introduce  it  with  any  more  ease  than  he  did 
at  the  first  trial,  until  he  had  succeeded  in  passing  it  ten 
times  ;  that  is,  after  the  fifth  day,  having  introduced  it 
overs  twelve  hours.  As  the  difficulty  to  introduction  at 
first  was  the  increased  size  of  the  Prostate  (Hand,  nothing 
but  its  subsidence  in  some  degree,  could  in  any  manner 
modify  this  obstruction  to  the  passage  of  the  instrument, 
which  at  first  had  made  him  persist  for  an  hour  rind  a 
half,  before  he  succeeded  m  introducing  it.    in  another 

f 


42 

case,  he  was  compelled  to  continue  the  use  of  the  catheter 
three  weeks,  before  t  -e  enlargement  of  tus  Gland  would 
permit  the  patient  to  pass  his  urine ;  after  which  time  all 
impediment  ceased. 

From  both  these  cases,  I  am  persuaded,  that,  had  he 
continued  the  use  of  tne  catheter  or  bougie,  he  ^ould  have 
been  as  successful  as  M.  Dessault,  in  removing  this  Sclero- 
cele,  or  hard  tumour  of  the  Prostate  Gland. 

The  length  of  time  after  the  first  introduction  of  the 
bougie,  to  the  first  sign  of  diminution  in  the  size  of  the 
Prostate  Gland,  being  from  two  to  six  weeks,  makes  the 
analogy  between  the  affection  of  this  Gland,  and  the  tes- 
ticles, still  stronger :  for  in  all  the  cases  of  the  latter,  re- 
corded by  M.  Ramsden,  not  one  of  them  lasted  more  t!  an 
six  weeks  after  the  first  introduction  of  the  bougie,  and  in 
very  few  of  these  cases,  was  it  necessary  to  employ  any  lo- 
cal application  to  the  part. 

Whether  the  same  success  would  attend  the  treatment 
of  the  prostate,  it  being  a  part  possessed  of  less  powers  of 
restoration  than  the  testicles,  we  cannot  positively  deter- 
mine; yet  it  is  certain  from  the  authors  already  referred  to, 
that  cases  of  it  have  thus  been  cured  ;  that  we  can  succeed 
in  removing  the  cause  of  it,  and  if  in  so  doing,  we  can 
cause  it  to  subside  in  some  degree,  so  as  materially  to  re- 
lieve the  patient,  it  is  a  great  point  gained.* 

*  l  was  informed  by  Dr.  Clussman,  of  Brooklyn,  that  he  had  had  several  pa- 
tients affected  with  an  enlargement  of  the  prostate  gland,  in  whom  he  employed 
M.  Dassault's  plan  of  treatment  by  the  bougie  but  that  he  had  never  been  able 
to  ascertain  its  perfect  success,  for  the  patients  finding  themselves  relieved,  dis- 
appeared, taking  the  bougie  with  them,  until  last  year  he   had  another  case,  in 


43 

The  bougie,  or  catheter  to  be  employed  in  tvose  cases, 
must  be  longer  t'nan  those  in  common  use.  Upon  this 
point  all  are  agreed;  but  as  to  the  alteration  which  takes 
place  in  that  pari  of  the  urethra,  which  makes  it  neces- 
sary to  adopt  a  different  instrument  from  that  generally 
used,  we  have  different  opinions. 

M.  Dessault  recommends  a  catheter  two  inches  longer 
than  that  which  is  usually  employed,  although  we  do  not 
know  his  reason  for  so  doing.  He  says,  "  we  must  con- 
ceive that  the  swelling  of  this  gland  can  scarce  take  place, 
wit'iout  in  some  degree  contracting  that  part  of  the  urethra 
which  it  embraces."* 

Mr.  Weldon  makes  use  of  a  similar  catheter,  but  his 
reason  for  so  doing  is  more  apparent  than  the  former ;  his 
remarks  are,  "  it  has  already  been  observed  that  in  this 
disease,  that  portion  of  the  urethra  situated  within  the 
Prostate  Gland  becomes  much  longer,  more  curved,  and  at 
the  same  time  wider,  than  in  its  natural  state.  It  has 
likewise  been  observed  that,  when  a  retention  of  urine 
takes  place  in  this  disease,  it  is  necessary  therefore, 
that  the  catheter  used  in  these  cases,  be  one  inch  and  a 
half,  or  two  inches  longer  than  in  other  cases :  at  the  same 
time  its  curvature  ought  to  be  increased  in  proportion  to 
the  increased  curvature  of  the  urethra,  especially  towards 
the  point." 

the  person  of  Capt.  M.  living  in  the  house  with  him,  in  which  he  completely 
succeeded  in  removing  all  the  diseases  of  this  part. 

I  asked  him  hit  opinion  concerning  the  cause  of  this  disease,  he  answered  hr 
WM  enable  to  form  any  satisfactory  OOC. 

'  Cbirorgical  Journal,  p,  71 


M 

Mr.  Home  coincides  with  Mr.  Weldoa  as  to  the  state 
of  the  urethra;  his  observation,  speaking  of  a  particular 
case,  is,  "  the  space  between  the  tumor  in  the  bladder  and 
the  bulb  of  the  urethra,  was  unusually  short,  which  is  the 
reverse  of  what  is  commonly  met  with,  &)c"h  and  of  course 
more  curved  than  natural  :  the  lobes  then  falling  together, 
offer  a  complete  obstruction  to  the  passage  of  the  urine. 
Mr.  Home  contends,  however,  that  it  is  the  enlargement 
of  a  particular  lobe  of  this  gland  (which  he  believes  to 
have  himself  discovered)  only,  which  can  form  a  sufficient 
obstruction  to  make  the  disease  of  any  importance. 

He  endeavoured  to  find  this  third  lobe  in  the  natural 
state  of  the  parts.  The  gentleman  employed  in  dissecting 
for  him  reported,  that,  "  in  doing  this,  a  small  rounded  sub- 
Stance  was  discovered,  so  much  detached,  that  it  seemed  a 
distinct  gland,  and  so  nearly  resembling  Cowper's  glands 
in  size  and  shape,  as  they  appeared  in  the  same  subject, 
in  which  they  were  unusually  large,  that  it  appeared  to  be 
a  gland  of  that  kind.  It  could  not  however  be  satisfacto- 
rily separated  from  the  Prostate  Gland ;  nor  could  any  dis- 
tinct duct  be  found  leading  into  the  bladder." 

From  the  circumstances  of  its  not  being  satisfactorily 
separated  from  the  Prostate  Gland,  it  is  doubtful  whether 
it  be  a  part  which  may  be  met  with  in  every  subject. 
Moreover,  if  it  were  really  a  third  lobe,  why  is  it  not  pro«. 
vided  with  excretory  ducts  like  the  others  ?  But  it  is  as 
other  preternatural  parts  of  a  gland,  which  are,  not  unfre- 

b  Home,  Prac.  Obs.  on  the  treatment  of  the  Pros.  Gland.  p,7. 


45 

quently  known  to  have  ducts  terminating  in  blind  extre- 
mities :  if  it  were  a  distinct  lobe  it  would  be  equally  liable 
to  increase,  and  in  the  same  progression,  from  the  same 
causes  as  the  other  two,  and  this  disease  would  terminate 
fatally  in  a  much  less  time  than  it  usually  does.     Besides, 
Mr.  Home  adds  "  a  similar  examination  was  made  of  this 
part  in  five  different  subjects.     The  appearance  was  not 
exactly  the  same  in  any  two  of  them.     In  one  there  was 
no  apparent  glandular  substance,  but  a  mass  of  condensed 
cellular  membrane  :  this,  however,  on  being  cut  into,  dif- 
fered from  the  surrounding  fat.   In  another  there  wasa  lobe 
blended  laterly  with  the  sides  of  the  Prostate  Gland,"0 
which  leads  me  to  conclude  that  if  it  be  actually  a  lobe, 
it  is  a  lusus  naturae  or  that  it  is  like  other  glandular  bodies, 
sometimes  lobulated  or  fissured,  as  obtains   not  unfre- 
quently  in  the  spleen.    But  Morgagni  entertains  a  similar 
opinion,  for  he  has  described  a  third  lobe  as  distinctly  as 
Mr.  Home,  although  the  latter  is  unwilling  to  allow  him 
the  credit  of  it.   In  a  quotation   he  makes  from  him,  he 
thinks  his  claim  to  discovery  is  firmly  established,  he  says, 
"  it  is  evident  that  Morgagni  had  no  idea  that  there  was 
any  conformation  of  the  Prostate  Gland,  that  could  ac- 
count for  this  tumor,  and  believed  that  it  arose  from  the 
body  of  the  gland."     How  much  Morgagni  believed  as 
Mr.  Home  is  willing  to  make  him  appear  to  do,  we  may- 
see  from  the  very  next  passage.  Referring  to  a  case  he  had 
formerlv  mentioned,  he  ob9erve9,ct  in  the  meanwhile  yon 


r.  in. 


46 

.may  add,  to  t^-ese  other  examples,  that  old  Physician, 
whom  one  of  the  observations  referred  to,  in  Vallesneri, 
shows  to  have  1  ad  the  w^ole  Prostate  Gland  tumid,  but  in- 
creased with  a.  particular  lobe,  as  it  were  from  its  glandular 
substance,  (thereby  meaning  t^e  body  of  the  gland)  which 
rose  up  within  the  bladder  in  the  shape  and  size  of  a  wal- 
nut." Mr.  Home  also  says,  that  in  tracing'  this  third  lobe, 
it  was  lost  in  the  substance  of  t^e  Gland.  And  furt1  er, 
Morgagni  in  bis  observation  of  another  case:  "  when  the 
anterior  paries  of  the  bladder  was  cut  asunder  longi- 
tudinally, in  that  part  of  the  opposite  paries  which  is 
nearest  to  the  orifice,  and  in  the  very  middle  of  this  part, 
a  roundish  protuberance  appeared,  being"  of  the  bigness  of 
a  small  grape,  covered  over  with  the  internal  coat  of  the 
bladder. 

"  What  this  protuberance  was  T  readily  supposed  ;  and 
by  forcing  the  knife  into  it,  T  cut  through  this  and  the 
contiguous  Prostate  Gland,  at  the  same  time,  lengthwise, 
and  shewed  that  it  was  of  the  same  nature  with  that  gland : 
that  it  was  very  evidently  continued  from  it ;  and  that 
there  was  no  doubt  but  if  it  had  grown  out  to  a  greater 
degree,  it  must  have  been  a  very  considerable  impediment 
to  the  discharge  of  urine."d  Again,  he  met  with  an  in- 
stance in  which  there  was  a  third  lobe,  on  the  posterior 
side,  towards  the  rectum,  which  fact  proves  it  to  be  of  ac- 
cidental occurrence. 

But,  as  before  observed,  Mr.  Home  thinks  that  unless 
this  middle  lobe  be  enlarged,  no  serious  symptoms  can  su- 

jj  Alexander's  Morgagni. 


47 

pervene.  This  observation  is  certainly  not  correct ;  for 
the  enlargement  ol  the  lateral  iobe  will  cause  as  complete 
retention,  as  can  possibly  be  occasioned  by  the  enlarge- 
ment of  the  middle  one  :  and  there  is  a  specimen  preserv- 
ed, in  the  Anatomical  Museum  of  this  college,  in  which 
nothing  but  a  regular  enlargement  of  that  substance 
which  we  commonly  call  the  prostate,  without  the  least 
additamentum  of  the  middle  lobe,  or  any  thing  else  pro- 
jecting into  the  biadder,  w  ich  can  in  any  way  be  com- 
pared to  t;.e  "  nipple  like  process"  spoken  of,  is  to  be 
seen;  but  there  is  a  regular  projection  of  the  whole  gland 
into  it,  which  raises  its  coats  so  as  efiectually  to  form  the 
"  membranous  bridle,"  mentioned  by  Mr.  Home,  which 
in  the  attempts  to  evacuate  the  urine,  must  have  been 
pressed  by  this  fluid  against  the  oritice  of  the  urethra,  so 
as  completely  to  close  it,  which  occasioned  the  death  of 
the  patient  as  readily  as  if  the  gland  had  had  an  addition 
of  a  dozen  lobes. 

Morgagni  also  says,  "  the  whole  Prostate  Gland  is  not 
always  tumid  ;  for  frequently  only  the  superior  circum- 
ference of  it  either  grows  out  on  every  side,  or  on  a  parti- 
cular part,  and  swells  to  such  a  degree  as  to  prevent  the 
exclusion  of  the  urine  ;"  e  which  gives  us  to  understand 
that  a  complete  retention  may  take  place  from  the  swel- 
ling of  the  other  parts  of  the  gland,  and  that  this  enlarge- 
ment of  the  superior  part  of  its  circumference  (which  is 
called  the  middle  lobe)  occurs  sometimes  only. 

•  Alexander'*  EtforgafoiTchap.  XLT. 


48 

I  do  not  pretend  to  deny  the  existence  of  a  third  lobe, 
but  that  it  is  not  this  only  which  is  of  importance.  I 
think  Mr.  Home  has  acted  in  conformity  to  what  he  has 
advanced,  that  "  it  is  much  easier  to  take  up  some  few  in- 
stances of  an  uncommon  kind,  and  shape  our  practice  to 
these  particular  cases."  That  he  has  in  some  instan- 
ces mistaken  the  projection  of  the  upper  posterior  edge 
of  the  Prostate  Gland  into  the  bladder,  for  a  middle  lobe, 
and  which  has  caused  him  to  say  "  as  it  is  this  particular 
lobe,  which  in  its  enlargement  closes  up  the  entrance  of 
the  bladder,  I  have  directed  my  observations  to  that  par- 
ticular part,  at  the  same  time  I  have  not  passed  over 
the  enlargement  of  the  other  portions  of  this  Gland,  nor 
been  unmindful  of  its  effects  in  keeping  up  irritation,  and 
interfering  with  the  passing  of  instruments  into  the  blad- 
der. These  are  circumstances  of  considerable  importance, 
but  are  not  direct  symptoms  of  the  disease,  which  produ- 
ces an  impediment  to  the  passage  of  the  urine.  Those  entire- 
ly arise  from  the  enlargement  of  the  middle  lobe{."  But  un- 
fortunately for  Mr.  Home,  he  appears  to  have  forgotten 
himself,  for  in  describing  the  state  of  parts  as  represented 
in  his  tenth  plate,  he  says,  "  the  mere  inspection  of  these 
parts  is  sufficient  to  show  that  no  urine  could  have  been 
voided  by  the  spontaneous  efforts  of  the  patient(»).  It 
must  be  observed,  that  in  this  case  only  one  of  the  lobes  of 
this  gland  was  enlarged,  and  this  was  the  left  lateral  lobe. 

This  projection  of  the  middle  lobe  into  the  bladder,  is 

(f)  Home,  treatment  of  the  diseases  of  the  Prost.  Gland,  p.  16. 
(s)  Ibid.  p.  268. 


49 

said  sometimes  to  be  attacked  by  ulceration,  from  the  sur- 
face of  which  a  fungus  arises:  but  this  however  is  of  rare 
occurrence. 

(■fan  affection  similar  to  this,  that  is,  of  a  fungus  ex- 
crescence arising  from  the  ulcerated  surf  ace  of  the  middle 
lobe  of  the  Prostate  Gland,  Mr.  Home  supposes  Doctor  Foth- 
ergill  to  have  died :  but  in  his  case  the  fungus  was  situ- 
ated much  above  the  Prostate  Gland,  which  as  related  by 
Dr.  Lettsom  was  not  sufficiently  enlarged  in  any  way  to 
project  into  the  bladder.  Dr.  Fothergill  was  subject  to 
calculous  affections,  as  was  proved  upon  dissection.  These 
calculi  will  cause  ulceration  at  the  neck  of  the  bladder;  and 
"  when  the  neck  of  the  bladder  is  become  ulcerated,  a  fun- 
gus may  form  from  the  diseased  surface,  and  cause  a  re- 
tention of  urine."  (g )  Such  I  conceive  the  case  of  Dr  Fother- 
gill  to  havebeen  ;  the  occasional  inflammation  of  the  fungus 
rendering  the  neck  of  the  bladder  and  the  urethra  irritable, 
end  thus  establishing  the  cause  for  the  enlargement  of 
the  prostate  gland  to  take  place,  which  was  only  of  se- 
condary consideration*  for  it  had  not  yet  attained  a  suffi- 
cient bulk  either  to  prevent  the  free  exit  of  the  urine  or 
to  offer  any  impediment  to  the  introduction  of  the  ca- 
theter; both  of  which  circumstances  when  they  did 
OCCUT,  were  caused  by  the  fungus  excrescence,  which, 
BTOte  apparently  "from  the  internal  coat  of  that  part  of 
iln:  bladdet  which  mn  >■<  rt  to  its  >ieck:h  that  the 
ate  WM  of  -!■•  ondary  consideration,  and  no  way 
(«  Wrl.lnii,  ou.  on  Paiiet  the  btadd«r  p.  120. 
LetUoinn  account  of  the  <•;»»<•. 


50 

concerned  in  the  production  of  the  disease,  we  infer 
from  the  observation  of  the  narrator.  "  The  Prostate 
Gland  was  enlarged,  and  by  no  means  in  a  natural  state." 
Certainly  so  accurate  an  observer  as  Dr.  Lettsom, 
would  have  been  able  to  tell,  whether  this  fungus  did, 
or  did  not  arise  from  the  ulcerated  surface  of  one  of  the 
lobes  of  the  Prostate  Gland. 

There  are  many  such  examples  mentioned  by  Morgagni, 
who  quotes  a  case  from  Rhodius,  of  an  old  man  "  in 
whom  the  discharge  of  his  urine  had  been  rendered  very 
difficult  by  degrees:  and  finally,  mucus  being  added  was 
entirely  obstructed  by  a  callous  appendage  growing  infernally 
to  the  orifice  of  the  bladder  alone"  &c. .-  and  the  following 
quotation  may  be  said  to  be  an  accurate  description  of  that 
which  occurred  in  Doctor  Fothergill:  "  from  the  pos- 
terior part  of  the  orifice,  (of  the  bladder)  a  body  the  size 
of  a  small  cherry  was  prominent  within  it,  and  the 
more  this  descended  through  the  beginning  of  the 
subjected  urethra,  the  more  and  more  was  it  extenu- 
ated, so  that  it  did  not  reach  to  the  seminal  caruncle."1 
This  last,  however,  is  much  smaller  than  that  which  was 
found  in  Docter  Fothergill's  bladder,  which  was  of  a «  py- 
riform  shape,  hard,  rough,  unequal,  on  its  surface,  Of  a  pale 
red  colour,"  the  fundus  of  which  was  much  higher  than 
the  prostate  gland,  and  its  neck  was  extenuated,  as  in  the 
last  case,  down  near  to  the  verumontanum,  or  as  it  is  called 
the  "  seminal  caruncle." 

1  Alexander's  Morg-agni. 


51 

This  dissertation  ^avinp-  already  swelled  to  an  uninten- 
tional length,  precludes  the  possibility  of  noticing  any  of 
the  other  diseases,  to  which  the  Prostate  Gland  is  occa- 
sionally subjected,  such  as  inflammation  ending  in  suppu- 
ration &c.  I  must  therefore  conclude  with  some  observa- 
tions on  the  treatment,  which  may  tend  to  the  alleviation 
of  the  affection  of  the  Prostate  Gland,  disagreeable  in  it- 
self, and  dangerous  in  its  consequences,  which  has  com- 
monly been  called  a  schirrous  enlargement,  but  which  we 
have  chosen  to  call  Sclerocele,  or  hard  tumor  of  this  gland, 
.as  better  characterizing  it. 

It  will  be  in  few  words ;  having  already  anticipated 
the  principal  part  of  it,  namely,  the  treatment "  by  the 
uret  .ra"  with  the  bougie,  together  with  a  seton  worn  in 
perineo,  which  last  of  itself,  we  are  assuredk  has  caused  a 
considerable  reduction  of  the  tumor  of  this  gland,  greatly 
*o  the  relief  of  the  patient. 

kMS.  notes  of  Professor  Mott's  lecture*. 


FINIS. 


COLUMBIA  UNIVERSITY 

This  boo.k  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

C2B(638)M50 

Su5 


■ 


